Cognitive and Behavioral Therapies

for Generalized Anxiety Disorder

Status: Strong Research Support

Description

Cognitive and behavioral therapies for generalized anxiety
disorder (GAD) refer to a variety of techniques that can be
provided individually or in combination. The basic premise
underlying the therapy approaches is that thoughts, feelings
and behaviors are inter-related, so altering one can help to
alleviate problems in another (e.g., changing negative
thinking will lead to less anxiety). The excessive,
uncontrollable worry that is the hallmark of GAD is thought to
be maintained through maladaptive thinking about the utility
of worrying, a tendency to repeat worries instead of
problem-solving, difficulties relaxing, and unhealthy
behaviors, including attempted avoidance of negative thoughts
and images, as well as situations that might provoke worry.
The cognitive therapy techniques focus on modifying the
catastrophic thinking patterns and beliefs that worrying is
serving a useful function (termed cognitive restructuring).
The behavioral techniques include relaxation training,
scheduling specific ‘worry time’ as well as planning
pleasurable activities, and controlled exposure to thoughts
and situations that are being avoided. The purpose of these
exposures is to help the person learn that their feared
outcomes do not come true, and to experience a reduction in
anxiety over time.

The research evidence suggests that both cognitive or
behavior therapy on their own can be helpful for GAD
(especially cognitive restructuring or applied relaxation).
However, there may be some advantage to combining the
approaches, with some studies finding that the treatment is
more powerful when therapy involves cognitive work, exposures
and relaxation. Cognitive Behavior Therapy (CBT) typically
refers to a combination of the various cognitive and
behavioral approaches, and ‘Anxiety Management Training’
usually refers to the particular combination of relaxation and
cognitive restructuring. The therapies can be conducted
individually or with a group, and CBT is helpful for older
adults with GAD as well. Typically, CBT will be conducted
in weekly sessions of 1–2 hours over the course of
approximately 4 months, for a total of 16–20 hours of
treatment.

Recent advances in therapies for GAD are promising,
including the use of emotion regulation, acceptance-based
and mindfulness approaches, an integrative therapy (that
incorporates specific strategies to address interpersonal
problems and emotional avoidance), as well as a
metacognitive perspective. However, there is not yet
sufficient research evidence to list these approaches as
empirically-supported. Similarly, CBT offered over the
computer may be of value, but further research is necessary.